How To Use CPT Code 0117U

CPT 0117U describes a proprietary laboratory analysis (PLA) test that evaluates a patient’s urine for specific biomarkers related to chronic pain. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0117U?

CPT 0117U can be used to report a proprietary laboratory analysis (PLA) test that assesses urine samples for specific biomarkers associated with chronic pain. This test, known as the Foundation PI test from Ethos Laboratories, utilizes liquid chromatography-tandem mass spectrometry (LC-MS/MS) to measure the levels of 11 endogenous analytes. These analytes include methylmalonic acid, xanthurenic acid, homocysteine, pyroglutamic acid, vanilmandelate, 5-hydroxyindoleacetic acid, hydroxymethylglutarate, ethylmalonate, 3-hydroxypropyl mercapturic acid (3-HPMA), quinolinic acid, and kynurenic acid.

2. Official Description

The official description of CPT code 0117U is: ‘Pain management, analysis of 11 endogenous analytes (methylmalonic acid, xanthurenic acid, homocysteine, pyroglutamic acid, vanilmandelate, 5-hydroxyindoleacetic acid, hydroxymethylglutarate, ethylmalonate, 3-hydroxypropyl mercapturic acid (3-HPMA), quinolinic acid, kynurenic acid), LC-MS/MS, urine, algorithm reported as a pain-index score with likelihood of atypical biochemical function associated with pain.’

3. Procedure

1. The laboratory analyst performs a quantitative test on a urine specimen using an automated analytical instrument.
2. The instrument utilizes liquid chromatography-tandem mass spectrometry (LC-MS/MS) to separate components and provide structural identity and quantification of individual components based on mass-to-charge ratio.
3. The test measures the levels of 11 endogenous analytes related to chronic pain, including methylmalonic acid, xanthurenic acid, homocysteine, pyroglutamic acid, vanilmandelate, 5-hydroxyindoleacetic acid, hydroxymethylglutarate, ethylmalonate, 3-hydroxypropyl mercapturic acid (3-HPMA), quinolinic acid, and kynurenic acid.
4. An algorithmic analysis of the test results, along with certain patient data, provides a pain-index score that indicates the likelihood of atypical biochemical function associated with pain.

4. Qualifying circumstances

CPT 0117U is appropriate for patients who require evaluation of chronic pain. The test assesses the levels of specific biomarkers in the urine that are indicative of chronic inflammation, neurotransmitter status, nerve health, and/or oxidative stress. It can help clinicians correlate abnormal biomarker findings with non-opioid therapies to optimize pain management regimens. The test is performed on a urine specimen and requires the use of LC-MS/MS technology.

5. When to use CPT code 0117U

CPT code 0117U should be used when a clinician orders the Foundation PI test from Ethos Laboratories to evaluate a patient’s urine for specific biomarkers associated with chronic pain. It is important to ensure that the test is performed by the specific laboratory offering the test and that the patient’s urine specimen is analyzed on a single date of service. This code should not be reported with any other CPT code.

6. Documentation requirements

To support a claim for CPT code 0117U, the following documentation is required:

• Order for the Foundation PI test from Ethos Laboratories
• Date of service
• Patient’s urine specimen details
• Results of the test, including the pain-index score
• Any additional relevant patient data used in the algorithmic analysis
• Signature of the clinician ordering the test

7. Billing guidelines

When billing for CPT code 0117U, ensure that the test is performed by Ethos Laboratories and that the patient’s urine specimen is analyzed on a single date of service. This code should not be reported with any other CPT code. It is important to check with the appropriate payer regarding payment for specimen collection, as some payers may reimburse separately for this service.

8. Historical information

CPT code 0117U, the Foundation PI test from Ethos Laboratories, was added to the Current Procedural Terminology system on October 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A patient with chronic pain undergoes the Foundation PI test from Ethos Laboratories to assess the levels of specific biomarkers in their urine.
2. A clinician orders the Foundation PI test for a patient with persistent pain to determine the likelihood of atypical biochemical function associated with their pain.
3. A patient on a prolonged pain management regimen undergoes the Foundation PI test to correlate abnormal biomarker findings with non-opioid therapies.
4. A clinician utilizes the pain-index score obtained from the Foundation PI test to optimize the treatment plan for a patient with chronic pain.
5. A patient with chronic inflammation and pain undergoes the Foundation PI test to evaluate their biochemical markers and guide the selection of appropriate therapies.
6. A clinician orders the Foundation PI test for a patient with neuropathic pain to assess their neurotransmitter status and nerve health.
7. A patient with chronic pain undergoes the Foundation PI test to evaluate their oxidative stress levels and determine the most suitable pain management approach.
8. A clinician utilizes the results of the Foundation PI test to develop an individualized pain management plan for a patient with atypical biochemical function associated with their pain.
9. A patient with chronic pain undergoes the Foundation PI test to assess the levels of specific biomarkers related to their pain and guide the selection of personalized treatment options.
10. A clinician orders the Foundation PI test for a patient with chronic pain to evaluate their metabolic profile and identify any abnormalities that may contribute to their pain.